Psychological Distress of Internal Medicine Residents Rotating on a Hematology and Oncology Ward: An Exploratory Study of Patient Deaths, Personal Stress, and Attributed Meaning.

OBJECTIVE

Effectively managing patient distress in oncology is challenging. Trainees in oncology experience distress along with their patients and patients' families, especially during an inpatient admission. This study evaluated the physician-in-training experience while working on an inpatient hematology-oncology ward.

METHODS

We collected a survey from internal medicine interns and residents at the end of a 2- or 4-week-long rotation on a hematology-oncology ward. It included the Impact of Events Scale-Revised (IES-R), a measure of distress, information about resident demography, rotation experiences with death, and personal circumstances that could affect distress levels. House officers were asked to provide comments regarding their most stressful experiences or how they were affected by dying patients.

RESULTS

Fifty-six residents completed questionnaires (58 % overall response rate) and scored IES-R 18.7 (SD 14.2) indicating that the majority (80 %) experienced significant clinical distress (IES-R ≥8) and 20 % experienced posttraumatic stress disorder (PTSD) levels of distress (IES-R ≥33). Comment themes are highlighted and included general frustration and death-related events. Forty-one (73 %) reported that their IESR was a death-related experience, and 39 (69.6 %) reported that attending to dying patients was the part of the rotation. Residents cared for 4.28 patients at the end of life on average during the rotation, and 68 % derived a sense of meaning from such work.

CONCLUSIONS

This study suggests that physician-trainee distress is significantly elevated while working on a hematology-oncology ward and may relate to general frustration and death-related events. Further study should evaluate the etiology of medical trainee distress in oncology.